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When caring for patients using evidence-informed practice, which of the following does the nurse use?
- A. Clinical judgment based on experience
- B. Evidence from a clinical research study
- C. The best available evidence to guide clinical expertise
- D. Evaluation of data showing that the patient outcomes are met
Correct Answer: C
Rationale: Evidence-informed nursing practice is a continuous interactive process involving the explicit, conscientious, and judicious consideration of the best available evidence to provide care. Four primary elements are: (a) clinical state, setting, and circumstances; (b) patient preferences and actions; (c) best research evidence, and (d) health care resources. Clinical judgment based on the nurse's clinical experience is part of EIP, but clinical decision making also should incorporate current research and research-based guidelines. Evidence from one clinical research study does not provide an adequate substantiation for interventions. Evaluation of patient outcomes is important, but interventions should be based on research from randomized control studies with a large number of subjects.
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The nurse is caring for a patient with a new diagnosis of pneumonia and explains to the patient that together they will plan the patient's care and set goals for discharge. The patient asks: 'How is that different from what the doctor does?' Which response by the nurse is most appropriate?
- A. The role of the nurse is to administer medications and other treatments prescribed by your doctor.
- B. The nurse's job is to help the doctor by collecting data and communicating when there are problems.
- C. Nurses perform many of the procedures done by physicians, but nurses are here in the hospital for a longer time than doctors.
- D. In addition to caring for you while you are sick, the nurses will assist you to develop an individualized plan to maintain your health.
Correct Answer: D
Rationale: This response is consistent with the Canadian Nurses Association (CNA) definition of nursing. Registered nurses are self-regulated health care professionals who work autonomously and in collaboration with others. RNs enable individuals, families, groups, communities and populations to achieve their optimal level of health. RNs coordinate health care, deliver direct services, and support patients in their self-care decisions and actions in situations of health, illness, injury, and disability in all stages of life. The other responses describe some of the dependent and collaborative functions of the nursing role but do not accurately describe the nurse's role in the health care system.
Which action by a newly graduated RN working on the postsurgical unit indicates that more education about delegation and assignment is needed?
- A. The nurse delegates measurement of patient oral intake and urine output to an unregulated care provider.
- B. The nurse delegates assessment of a patient's bowel sounds to an experienced unregulated care provider.
- C. The nurse assigns an LPN/RPN to administer oral medications to several patients.
- D. The nurse assigns a 'float' RN from pediatrics to care for a patient with diabetes.
Correct Answer: B
Rationale: Assessment requires RN education and scope of practice and cannot be delegated to an unregulated care provider. The other actions by the new RN are appropriate.
The nurse is caring for a patient who has been admitted to the hospital for surgery and tells the nurse, 'I do not feel right about leaving my children with my neighbour.' Which action should the nurse take next?
- A. Reassure the patient that these feelings are common for parents.
- B. Have the patient call the children to ensure that they are doing well.
- C. Call the neighbour to determine whether adequate childcare is being provided.
- D. Gather more data about the patient's feelings about the childcare arrangements.
Correct Answer: D
Rationale: Since a complete assessment is necessary in order to identify a problem and choose an appropriate intervention, the nurse's first action should be to obtain more information. The other actions may be appropriate, but more assessment is needed before the best intervention can be chosen.
Which of these nursing actions for the patient with heart failure is appropriate for the nurse to delegate to experienced unregulated care providers?
- A. Assess for shortness of breath or fatigue after ambulation.
- B. Instruct the patient about the need to alternate activity and rest.
- C. Obtain the patient's blood pressure and pulse rate after ambulation.
- D. Determine whether the patient is ready to increase the activity level.
Correct Answer: C
Rationale: Unregulated care provider education varies according to the type of worker, however, unregulated care providers are able to measure vital signs. Assessment and patient teaching require RN education and scope of practice and cannot be delegated.
Which of the following includes the components required for a complete nursing diagnosis statement?
- A. A problem and the suggested patient goals or outcomes.
- B. A problem, its cause, and objective data that support the problem
- C. A problem with all its possible causes and the planned interventions
- D. A problem with its etiology and the signs and symptoms of the problem
Correct Answer: D
Rationale: The PES format is used when writing nursing diagnoses. The subjective, as well as objective, data should be included in the defining characteristics. Interventions and outcomes are not included in the nursing diagnosis statement.